Mr Mrs Miss Ms    Other    Date:

First Name:    Last Name:

Address:

Postal Town/City Post/Zip Code:

County (UK)/State (US)/ Province/Region

Country:   E-mail: 

Telephone:    Fax:

Please state any Bank you do not wish to deal with:

Please identify any financial problems you may have had ANYWHERE IN THE WORLD;  this will assist us in finding the right account for you.

Offshore Bank accounts:   Please state type of Bank Account required:

Account  (Personal)...... Introduction Fee £300  

Account (Business)...... Introduction Fee £450   Limited Company      "Trading As ..."    

EITHER:  I enclose cheque/postal/money order for £ for the above fees payable to  "Jayga Ltd"

OR:  Please send bank details for wire transfer of funds.

Please print form now using the print facility on your browser.  Sign the printed copy and mail to Jayga Ltd at PO Box 5854, Wimborne, BH21 3ZS, United Kingdom with:

Personal application:

• your remittance

• a certified* photocopy of your passport including the photograph and signature page

• 2 recent utilities bills. 

Limited Company application:

• your remittance

• original of Certificate of Incorporation

• original or certified* copy of Memorandum & Articles of Association

• certified* photocopies of Directors' and Company Secretary's passports including photo page

• 2 recent utility bills from each of the above.

*certified = officially stamped and clearly certified as a true copy by a bank, solicitor or accountant.

Statement

I/We the undersigned request Jayga Ltd to arrange an introduction to a bank for the opening of an account with the facilities referred to above.  I/We agree to pay the above fees which are refundable in full if an application is unsuccessful and the service not provided.   I/We understand that Jayga Ltd is acting as an intermediary, providing information and referrals only and does not offer credit, deposit or banking facilities nor any guarantee of the bank or its performance.  Any deposits which may be required to open the account will be payable directly to the appropriate financial institution.

Signed : ______________________________________________  Date:  ____________________________

(1) From time to time we may wish to contact you by email, telephone or post about our new services, products or special offers which may be of interest to you.   If you do not wish to be contacted in this way, please check box

(2) We may also wish to contact you occasionally about services, special offers and products that third parties are offering and that we believe may be of interest to you.  If you do not wish to be contacted for marketing purposes, please check box

It would be helpful to us to know how clients heard about us and we should be grateful if you would kindly indicate if this was by (a) searching the internet ,    (b) press advertisement  ,   or (c) recommendation, in which case please state from whom